pro-indemnity.co.uk
Let and Unoccupied Property Form
1. Your Name:
2. Correspondence address:
Postcode:
Telephone Number:
E-mail:
3. Address of property to be insured:
4. Buildings sum insured (rebuilding cost):
£
5. Type of property:
Number of bedrooms:
6. Construction:
Is property purpose built?:
Purpose BuiltConverted-
Walls (eg: brick, stone etc.):
Roof (eg: titles, slate etc.):
Floors (eg: wooden, concrete ):
Any flat roof area (approx. percentage):
%
7. Year of build (approx.):
8. Is the property:
A listed building?
Yes No
If yes, what grade?
Near a riverbank?
If yes, approx. distance from riverbank:
metres
9. Security
Smoke Detectors fitted?:
Alarm fitted?:
If alarm fitted, please give type:
to Police Stationto Central Monitoring StationPrivate line to keyholderBells only-
Locks fitted on Doors & Windows?:
Safe Installed?:
Security Lights installed?:
Neighbourhood Watch area?:
10. Is Property Currently occupied?:
If so, type of tenants:
ProfessionalStudentsDHSSOther-
Who is your tenancy agreement with?
TenantDHSS-
11. Type of lease:
LandlordHousing AssociationLandlord via management company-
Length of lease:
Less than 6 monthsMore than 6 months-
12. If unoccupied, please state reason:
13. Value of Landlords contents (if any):
14. Potential loss of rental income (if any, or cost of alternative accommodation. Note that this is normally 20% of building sum insured ):
15. Subsidence cover required?:
16. How long have you owned property?
17. Any claims?
If yes, please provide details
Date of claims
What happened (eg fire, theft, storm, flood)
Total Payment
1.
2.
3.
4.
18. Current insurers: (so we don't approach them)
19. Expiry date:
20. Target premium: (if known)
21. Is there a mortgage lender?
If "Yes" please provide name and address (if known)
Please supply me with an estimate within 105 working days. (We will attempt to meet the target, but please be aware that it does require our insurers to respond quickly as well!)
Done
Please check your details, and when you are happy that all is correct, tick the 'Done' box and then click the Submit button above...